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Thursday, 5 December 2013

.Neutropenia - The Rsk Factors

Neutropenia is defined as a condition of  abnormally low number of neutrophils, as a  result of granulocyte disorder of that leads to Immunodeficiency with lower than normal  circulating white blood cells. Patients with neutropenia are susceptible to bacterial infections causes of neutropenic sepsis.
Neutropenia is either problems in the production of the cells by the bone marrow and destruction of the cells from somewhere else in the body, if  neutrophil count falls below 1,000 cells per microliter of blood.
Neutropenia can be classified into acute and chronic types, depending to the duration of the illness. Some researchers divided severity of the disease, depending to the absolute neutrophil count (ANC) and is described as follows(a).
1. Mild neutropenia, when the ANC falls below a lower limit of 1500 per mm3 (1.5 x 109 /1), but remains higher than 1000 per mm3 (1.0 x 109 /1).
2. Moderate neutropenia, when the ANC falls between 500 per mm3 and 1000 per mm3 (0.5 x 109 /1 - 1.0 x 109 /1)
3. Severe neutropenia, when the ANC falls below 500 per mm3 (0.5 x 109 /1)
Risk factors
1. H-ficolin
According to the study by the Department of Pediatrics, University of Bern, Bern, low concentration of H-ficolin was associated with an increased risk of FN, particularly FN with bacteraemia, in children treated with chemotherapy for cancer. Low H-ficolin thus represents a novel risk factor for chemotherapy-related infections(16).

2. Deficiency of mannose-binding lectin
Mannose-binding lectin-associated serine protease-2 (MASP-2) is an essential component of the lectin pathway of complement activation. According to the study by the University of Bern, MASP-2 deficiency was associated with an increased risk of FN in children treated with chemotherapy for cancer. MASP-2 deficiency represents a novel risk factor for chemotherapy-related infections(17).

3. Poison
Exposure to certain poison are associated to the increased risk of the disease(18).
According to the article of Delaware physician care, an aetna health plan, indicated the following risk factors(19).


4. Chemotherapy Regimen 
The aggressiveness of the chemotherapy regimen can be taken into account by giving to each individual drug a score (ranging from 0 to 4), according to its expected hem atological toxicity . For combination drug regimens, the regimen’s score is calculated by taking the mean of the individual agent’s weights. (Example: vinblastine + carboplatin = 5 ÷ 2= 2.5). A score ≥3 is considered high risk for neutropenia

5. Pre-existing neutropenia
a. Age >65 of age
b. Previous chemotherapy or radiation therapy
c. Advanced disease or uncontrolled cancer
d. Pre - existing n eutropenia, anemia or other cytopenias, or b one marrow involvement of tumor
e. Act ive Infection/open wounds, pneumonia, sepsis o Poor performance status (e.g., poor nutritional status, low albumin)
f. Renal impairment (GFR<30 or age >65 and elevated creatinine)
g. Liver dysfunction (elevated bilirubin, alkaline phosphatase)
h. Other serious co - morbidities (heart disease, hypertension, COPD)
i. Previous episodes of FN
g. A previous neutropenic complication in the immediate previous cycle with no plan to reduce dose intensity(19).
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Sources
(a) http://www.neutropenia.ca/about/what-is-neutropenia
(16) http://www.ncbi.nlm.nih.gov/pubmed/19659773
(17) http://www.ncbi.nlm.nih.gov/pubmed/17984804
(18) http://www.mdguidelines.com/neutropenia
(19) http://www.delawarephysicianscare.com/Content/Docs/ColonyStimulatingFactors-PharmacyPAGuideline-DE.pdf